The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
-
J. Heart Lung Transplant. · Apr 2014
EditorialBiomarkers for the prognosis of pulmonary arterial hypertension: Holy Grail or flying circus?
Despite recent and major progresses in the field of pulmonary vascular diseases pulmonary arterial hypertension (PAH) outcome still needs improvement. In parallel, several changes are observed in a disease that is no longer described as typically affecting young women. This is outlined in the most recent reports from PAH registries, where increasing age at the time of diagnosis is constantly described. ⋯ Yet, even if there are probably few chances, if any, to discover the "Holy Grail", researcher's efforts must continue. The combination of pertinent parameters in composite scores is indeed promising and emphasized in the most recent PAH guidelines. Clinicians would probably need to use a subtle combination of several biomarkers and clinical, functional, hemodynamic and right ventricular parameter criteria to drive the most ambitious treatment goals in a complex and life threatening disease.
-
J. Heart Lung Transplant. · Jan 2014
EditorialThe vexing problem of thrombosis in long-term mechanical circulatory support.
Durable left ventricular assist devices (LVADs) have not only enhanced longevity but also conferred sustained improvements in quality of life, symptom control, and functional capacity in patients with medically refractory advanced heart failure. Problems with device-related infection, bleeding, neurologic events, right-sided heart failure, and device malfunction have dominated the clinical care of patients living on mechanical support. ⋯ By 2012, the problem of thrombosis in LVADs began to consume most of the scientific direction as centers and collaborative groups began to dissect this nascent phenomenon. In this perspective, we describe the magnitude and implications of pump thrombosis, discuss secular and management trends in this unique population, attempt to dissect the problem at its root, offer guidance on surveillance and therapeutic principles, and outline issues that deserve our immediate and collaborative attention.
-
J. Heart Lung Transplant. · Nov 2005
Editorial CommentThe revised ISHLT heart biopsy grading scale.